Overview of ibuprofen poisoning in children and adolescents
- Rebecca T Kirkland, MD, MPH
Rebecca T Kirkland, MD, MPH
- Professor of Pediatrics
- Baylor College of Medicine
- Section Editor
- Michele M Burns, MD, MPH
Michele M Burns, MD, MPH
- Section Editor — Pediatric Toxicology
- Assistant Professor of Pediatrics
- Harvard Medical School
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
Ibuprofen is a nonsteroidal antiinflammatory drug (NSAID) that is available over-the-counter and is commonly ingested by children and adolescents. After oral overdose, most patients are asymptomatic and few require supportive care or hospitalization. However, patients who ingest more than 400 mg/kg of ibuprofen are at risk for serious toxicity, including apnea, bradycardia, hypotension, severe metabolic acidosis, polyuria with renal failure, coma, and seizures.
The evaluation and management of acute overdose of ibuprofen in children and adolescents is reviewed here. The management of acute overdose of nonsteroidal antiinflammatory drugs, including ibuprofen, in adults and the chronic toxicity of NSAIDs is discussed separately. (See "Nonsteroidal antiinflammatory drug (NSAID) poisoning" and "Nonselective NSAIDs: Overview of adverse effects".)
Ibuprofen is a nonsteroidal antiinflammatory drug (NSAID) that has been available as an over-the-counter preparation since 1984 . In the nine years prior to 1984, 100 million prescriptions for ibuprofen were written in the United States with only 67 cases of overdose or accidental ingestions reported, 25 of which occurred in children younger than three years of age . According to the American Association of Poison Control Centers’ National Data System, since being available over-the-counter, ibuprofen accounts for almost 70,000 exposures in children and adolescents annually with the majority of reports occurring in children under six years of age . (See "Nonsteroidal antiinflammatory drug (NSAID) poisoning".)
MECHANISM OF ACTION
Ibuprofen is a propionic acid derivative. Like other NSAIDs, it inhibits cyclooxygenase (prostaglandin synthase), thereby impairing the ultimate transformation of arachidonic acid to prostaglandins, prostacyclin, and thromboxanes (figure 1). Ibuprofen has analgesic, antipyretic, antiinflammatory, and uterine muscle effects that largely are mediated by reduced prostaglandin synthesis although other mechanisms of action are proposed. (See "NSAIDs: Mechanism of action".)
The pharmacokinetics of ibuprofen are as follows (see "Nonsteroidal antiinflammatory drug (NSAID) poisoning", section on 'Kinetics'):
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- MECHANISM OF ACTION
- SIDE EFFECTS
- Adverse effects
- - Patients at increased risk
- CLINICAL FEATURES OF ACUTE OVERDOSE
- ANCILLARY STUDIES
- - Coma, apnea, and hypotension
- - Seizures
- - Metabolic acidosis
- - Vomiting and gastritis
- Gastrointestinal decontamination
- Extracorporeal elimination
- ADDITIONAL RESOURCES
- SUMMARY AND RECOMMENDATIONS